RAPID RECOVERY AFTER JOINT REPLACEMENT-patient discharged on the third postop day!

Mrs. Joshi a 65 year old lady who had severe rheumatoid arthritis in all her joints came to ABMH to get relief from pain in her deformed knees. Her independence was lost and she was depressed with her inability to do even simple tasks of daily living. She could manage with her other joints but her knees prevented her from mobilizing across her house let alone the town.

She was very active till 6 months ago when the pain in her knees became unbearable. She could hear grinding in her knees and often the knee locked or gave way on her. She suffered a few falls as a result and was lucky to escape with only bruises.

She saw her neighbor’s speedy recovery following knee replacement surgery by Dr. KIran Kharat at ABMH and decided to go for a consultation.

A detailed consultation with Dr. Kharat followed and she decided to go ahead with her knee replacement surgery.

On operation Dr. Kharat noted severe bone destruction due to the synovitis and she also had osteoporosis. DR. Kharat said, “ I used a high flex design with a slender femoral component which was patella friendly. I had to reconstruct the lateral condyle of the femur with the patient’s own bone graft and implanted the Zimmer components with gentamycin cement”.

Dr. Kharat also uses the multimodal pain management program for all his knee replacement patients which assure a painfree postoperative period. This enables faster recovery and easy compliance with physiotherapy.

The patient started moving her knee on the same day of operation under the guidance of the physiotherapists. A CPM (Continuous passive motion) machine was also used. This machine gently moves the knee through a prescribed range of motion.

The epidural injection at a slow steady rate kept her pain free and soon on day one she was mobilized out of bed! By the third postop day the patient could use the commode and get in and out of bed on her own.

She was discharged on the evening of the third postoperative day and did supervised physiotherapy at home and took the prescribed drugs.

This case illustrated the strides made in the field of joint replacement surgery and proves that ABMH has the skills and the teamwork under the guidance of Dr. Kiran Kharat to guarantee better outcomes to patients crippled with arthritis and ensure their pain free mobility!

The population of India is aging. This demographic change brings along new medical challenges which are age related and affect various parts of the body. Arthritis is the number one disability not only in the USA but in Asia as well. The increasing trend towards affluence is leading to an obesity epidemic in India. Increased body weight directly affects the weight bearing joints which undergo wear and tear and succumb to arthritis. In addition, the typical Indian cultural apathy to exercise adds to the burgeoning problem of arthritis.

However there have been enormous strides in the super speciality of Orthopaedics which deals with Joint replacement surgery. Many international papers in peer reviewed journals of Orthopaedics have published long term follow-up data which show very good outcomes related to activity level and painless mobility.

However there are many patients who deny themselves an opportunity to get back their independence because they are scared of surgery. The most common reason is that they have heard of, or know someone who has not done well after surgery! The second common reason to deny or avoid surgery is the cost factor.

It is obvious that one cannot extrapolate the bad experience of one patient to oneself! The chances are that if the operation is done by an experienced surgeon backed with a good team using the best implant manufactured by a reputed company in a hospital which maintains good practice standards, then the outcome is likely to be good.

There are inherent risks in any operation but they are small and need to be disclosed to the patient. Infection, DVT (deep vein thrombosis), scar related problems, neurovascular problems in severe deformity, can be expected. However in percentage terms it is 5 % compared to a 95 % success rate!

With increased awareness this 5 % risk is also reduced significantly by premptive measures like using prophylactic antibiotics, clean air theatres, space suits, clean hand campaigns, DVT stockings and early mobilisation and judicious use of drugs to thin the blood. In some good centres the risk is nearly zero!

One must also caution the patient about delayed infection. It can happen many years after the index surgery! Lowered immunity, local trauma leading to haematomas, and high dose or longterm steroids can lead to this complication.

In such situations one requires to remove the old implant and do a staged revision procedure. If an accepted protocol is followed then the results of such revision surgery are satisfactory.

Thus there is no real need for fear! The patient should arrive at an informed decision after knowing all the facts about the proposed surgery and should not hesitate to ask questions to their Doctor! Once a good communication platform and rapport is established then the odds for a good outcome are high!